Sean K. v. Saul

          MEMORANDUM OPINION AND ORDER

          SUSAN E. COX, MAGISTRATE JUDGE

         Plaintiff Sean K.^[2] appeals the decision of the Commissioner of the Social Security Administration (“Commissioner”) denying his disability benefits. Plaintiff has filed a Memorandum in Support of Summary Remand, which the Court construes as a motion for summary judgment [17]; the Commissioner has filed a cross-motion for summary judgment [dkt. 24]. As detailed below, the Court grants Plaintiff's motion for summary judgment [dkt. 17], denies the Commissioner's motion for summary judgment [dkt. 24], and remands this matter for further proceedings.

         I. Background

         a. Procedural History

         Plaintiff applied for supplemental security income (“SSI”) Title XVI of the Social Security Act on September 30, 2014, alleging disability beginning on April 10, 2013. [R. 20.] After his applications were denied initially and on reconsideration, Plaintiff requested an administrative hearing. Id. On April 14, 2017, Plaintiff appeared with counsel and testified at a hearing before Administrative Law Judge (“ALJ”) Margaret A. Carey. [R. 43-84.] A vocational expert (“VE”) also testified. Id. On September 25, 2017, the ALJ determined that Plaintiff was not disabled. [R. 20-34.] On September 4, 2018, after a review of the ALJ's decision, the Appeals Council issued a decision affirming that Plaintiff had not been under a disability from his alleged onset date to the date of the ALJ's decision. [R. 1-6.] Thus, the Decision of the Appeals Council is the final decision of the Commissioner. Plaintiff filed an action in this court on November 6, 2018, seeking review of the Commissioner's decision. [Dkt. 1.]

         b. Relevant Medical Background

         Plaintiff was born in 1972 and was 42 years old on his alleged disability onset date. [R. 32.] Plaintiff has been diagnosed with peripheral neuropathy/polyneuropathy and degenerative disc disease. [R. 353, 507, 508, 516, 521, 641, 798, 801, 805, 806, 809, 813, 824, 829.] A July 2014 MRI of his lumbar spine showed numerous abnormalities including a bulging disc at the L4-5 level that “abuts the bilateral L5 nerve roots” and a “suspected annular fissure at ¶ 5-S1.” [R. 353.] A December 2014 EMG showed a “markedly abnormal study indicative of a chronic, severe, nearly complete, generalized, large fiber, peripheral sensorimotor, mixed axonal and demyelinating polyneuropathy with ongoing denervation in the intermediate and distal lower extremity areas” and “partial conduction block upon stimulating the left ulnar nerve above and below the elbow.” [R. 509-11.]

         Neurological exams with Dr. Sandeep Aggarwal, M.D., his treating neurologist, showed decreased motor strength in the intrinsic muscles of Plaintiff's left hand and both feet, decreased pinprick sensation from his hands to his forearms and from his toes to mid-tibia, absent vibration in his feet, reduced proprioception in his toes, reduced temperature from his hands to his forearms and from his toes to mid-tibia, positive Romberg tests, an inability to heel/toe walk and tandem walk, an antalgic gait, and decreased reflexes to his ankles. [R. 507, 516, 521, 801, 813, 828.] Plaintiff was prescribed a cane by Dr. Aggarwal, and Plaintiff testified he always uses it to walk (even short distances) since 2013. [R. 25, 72, 507.] However, Plaintiff did not bring his cane to the March 17, 2015 consultative medical examination with Dr. Roopa Karri, M.D., and he told Dr. Karri he had only been using a cane every day for the prior 6 months. [R.637-38.]

         c. The ALJ's Decision

         On September 25, 2017, the ALJ issued a written decision denying Plaintiff disability benefits. [R. 20-34.] At Step One, the ALJ found that Plaintiff had not engaged in substantial gainful activity since his alleged onset date of September 30, 2014. [R. 22.] At Step Two, the ALJ found that Plaintiff had the severe impairments of peripheral neuropathy/polyneuropathy and degenerative disc disease. Id. The ALJ also detailed Plaintiff's nonsevere impairments of obesity, diabetes, bilateral orchidopexy following testicular torsion, and a left ankle joint fracture status post repair surgery. [R. 22-23.]

         At Step Three, the ALJ determined that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments of 20 C.F.R. Part 404, Subpart P, App'x 1. [R. 23-24.] In reaching this conclusion, the ALJ considered Listing 1.04 for disorders of the spine and Listing 11.14 for peripheral neuropathy. Id.

         Before Step Four, the ALJ found that Plaintiff had the residual functional capacity (“RFC”)^[3]to perform sedentary work with the following nonexertional limitations: no ladders, ropes, or scaffolds; no kneeling, crouching, or crawling; only occasional stairs, ramps, and balancing; no exposure to unprotected heights or moving mechanical parts; frequent handling and fingering on the non-dominant left; a sit/stand option at will; and use of a cane for ambulating. [R. 24.] At Step Four, the ALJ determined that Plaintiff was capable of performing his past relevant work as a dispatcher security guard, which she identified as DOT #372.167-010 (sedentary exertional level as actually performed; SVP 6). [R. 31-32.] The ALJ also made alternate findings that Plaintiff could perform other sedentary work existing in significant numbers in the national economy. [R. 33.] Because of these determinations, the ALJ found Plaintiff not disabled under the Act. Id.

         II. Social Security Regulations and Standard of Review

         The Social Security Act requires all applicants to prove they are disabled as of their date last insured to be eligible for disability insurance benefits. ALJs are required to follow a sequential five-step test to assess whether a claimant is legally disabled. The ALJ must determine: (1) whether the claimant is currently engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; and (3) whether the severe impairment meets or equals one considered conclusively disabling such that the claimant is impeded from performing basic work-related activities. 20 C.F.R. § 404.1520; 20 C.F.R. § 416.920(a)(4)(i)-(v). If the impairment(s) does meet or equal this standard, the inquiry is over and the claimant is disabled. 20 C.F.R. § 416.920(a)(4). If not, the evaluation continues and the ALJ must determine (4) whether the claimant is capable of performing his past relevant work. Cannon v. Harris, 651 F.2d 513, 517 (7th Cir. 1981). If not, the ALJ must (5) consider the claimant's age, education, and prior work experience and evaluate whether she is able to engage in another type of work existing in a significant number of jobs in the national economy. Id. At the fourth and fifth steps of the inquiry, the ALJ is required to evaluate the claimant's RFC in calculating which ...